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Using intraligmentary dexamethasone to reduce the pain intensity during and after root canal preparation
Aim :asseing the effect of intraligmentary dexamethasone on anesthetic efficacy of inferior alveolar nerve block and buccal infiltratation in lower first molar with irreversible pulpitis and apical periodontits, dexamethasone has antiinflammatory effect so it will improve the efficacy of anathesia and reduce postoperative by inhibition the production of phosopholipase and reduction of prostaglandins synthesis
Methods: diagnose the case clinically and readiographically Patients will divide into 3 groups First group will be given inferior alveolar nerve block 4%articaine Hcl1:100 epinephrine Second group will be given inferior alveolar nerve block 4%articaine with intraligmentary dexamethasone Third group will be given buccal infiltratation 4%articaine with intraligmentary dexamethasone After anathesia ,make access cavity and reduce the occulsa surface and make it out of occulsion .
Working length determination will be done by apex locator and confirm it by x ray .
Mechanical preparation will be done by FANTA files and apply EDTA on files Irrigate the canal by Naocl 2.5Ùª Complete the root canal preparation through single visit. Obturate the canal by single cone technique and bioceramic sealer. During procedures , record pain intensity on HP visual scale Follow up the patient after 6,12,24 and 48 hours Describe Ibuprofen 200mg in case of sever pain Conclusion : it's predictable that the intraligmentary dexamethasone will reduce the pain during and after root canal procedures
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Inferior alveolar nerve block | Active Comparator | Using 1.8ml of 4% articaine HCL 1:100,000 epinehrine |
|
| Inferior alveolar nerve block with intraligmentary dexamethasone | Experimental | Using 1.8ml of 4% articaine HCL 1:100,000 epinehrine for inferior alveolar nerve block and 0.4 mL of 8 mg/ 2mLdexamethasone for intraligmentary injection |
|
| Buccal infiltratation with intraligmentary dexamethasone | Experimental | Using 1.8ml of 4% articaine HCL 1:100,000 epinehrine for buccal infiltratation and 0.4 mL of 8 mg/ 2mLdexamethasone for intraligmentary injection |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Inferior alveolar nerve block with dexamethasone | Procedure | Using articaine for inferior alveolar block with intraligmentary dexamethasone |
|
| Measure | Description | Time Frame |
|---|---|---|
| Intraoperative pain | Efficacy of buccal infiltration anesthesia and inferior alveolar nerve block measured during procedures of root canal treatment using numerical rating scale.It is a line numbered from 0-10 , where pain levels are categorized as follows: 0= no pain, 1-3 = mild pain, 4-6= moderate pain, 7-10= severe pain, "10" being the most intense pain conceivable.And instruct patient to raise his hand if he feels pain to reasse if he needs supplementary anathesia | During procedure |
| Measure | Description | Time Frame |
|---|---|---|
| Post-operative pain | Patient will record the pain on numerical rating scale (6,12,24 &48h)..It is a line numbered from 0-10 , where pain levels are categorized as follows: 0= no pain, 1-3= mild pain, 4-6= moderate pain, 7-10 = severe pain, "10" being the most intense pain conceivable | After procedure until 48hour |
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Inclusion Criteria:
Age between 20-45 years old.
Systemically healthy patient (ASA I or II).
Lower first molar with:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Wafaa R Elshafaey | Contact | 00201020773887 | wafaa.elshafaey@dentistry.cu.edu.eg | |
| Mohamed M Abi Elhassan, Phd | Contact | 0020 111 167 7707 |
| Name | Affiliation | Role |
|---|---|---|
| Angie G Ghoneim | Faculty of oral and dental medicine,Cairo university | Study Director |
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| Buccal infiltratation with dexamethasone | Procedure | Using articaine for buccal infiltratation with intraligmentary dexamethasone |
|
| Inferior alveolar nerve block | Procedure | Using articaine for injection |
|
| Number of needed analgesic tablets in case of intolerable pain |
Ibuprofen 200mgm tabs have been described to patient in case of sever pain (above6) |
| After procedure until 48hour |
| ID | Term |
|---|---|
| D003907 | Dexamethasone |
| ID | Term |
|---|---|
| D011246 | Pregnadienetriols |
| D011245 | Pregnadienes |
| D011278 | Pregnanes |
| D013256 | Steroids |
| D000072473 | Fused-Ring Compounds |
| D011083 | Polycyclic Compounds |
| D013259 | Steroids, Fluorinated |
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